{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Nathaniel C Beal","gend":0,"currentgend":"","add":"25 SANDY COVE RD","city":"BRIDGTON","state":"ME","zip":"04009","dob":"1955-01-19","age":"","mstatus":"","insh":"10000075641","cliId":"","pno":2072328787,"cno":"","email":"natcbeal@gmail.com","ename":"","eno":"","pphy":"SMITH, CRAIG M","ppno":6033565472,"pcpadd":"Primary Care at Memorial Hospital,3073 White Mountain Hwy","pcpcity":"North Conway","pcpstate":"NH","pcpzip":"03860","pcpcounty":"","pcpid":"","pcpname":"MAINEHEALTH PRIMARY CARE FAMILY INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"25 SANDY COVE RD","madd2":"","madd3":"","mcity":"BRIDGTON","mstate":"ME","mzip":"04009","pcpfaxno":6033569647,"pcpnpi":1689645566,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"7R82MH6MH02","medicaidid":"","pcpFlag":""},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["I480","Z981","Z0000","T84226A","M48061","I214","I5023","I4819","I130","R310","E1169","I4891","I3489","I517","I5189","E119","Z23","I5022","M109","I429","I2510","R931","M7138","M5450","N200","N281","I5021","Z472","E785","K219","E039","M9983","M4316","I428","R531","N1830","Z1211","M47816","N401","M5136","I5033","I38","R778","S299XXA","Z01818","M48062","M4326","M5416","G8194","M5126","R82998","E6601","M5127","M47817","T8484XA","Y838","R9431","M4306","R262","M4697"],"date":["2024-06-13","2025-04-14","2025-06-06","2025-03-21","2024-12-17","2023-01-10","2023-01-10","2023-01-23","2023-08-17","2023-04-19","2025-03-20","2023-01-10","2023-01-10","2023-01-10","2023-01-10","2025-10-08","2024-12-16","2024-08-27","2023-06-15","2023-01-09","2023-01-09","2023-01-09","2023-08-17","2024-11-18","2023-02-08","2023-02-08","2023-05-12","2025-03-21","2025-03-21","2025-03-21","2025-03-21","2023-08-17","2024-08-14","2024-06-13","2023-08-17","2023-06-05","2025-11-07","2024-12-17","2023-05-01","2023-06-07","2023-02-22","2023-02-22","2023-01-10","2023-01-07","2023-01-17","2023-08-17","2023-12-27","2025-01-16","2023-08-17","2024-12-17","2024-02-23","2023-01-06","2024-08-22","2024-08-22","2025-03-21","2025-03-21","2023-01-06","2022-05-24","2022-05-24","2022-06-10"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","UNIFINE PENTIPS","","","Select","Select",""],["","","INDOMETHACIN","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","LIDOCAINE","","","Select","Select",""],["","","METOPROLOL SUCCINATE","","","Select","Select",""],["","","GABAPENTIN","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","ULTRA-FINE MICRO PEN NEEDLE","","","Select","Select",""],["","","ELIQUIS","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","LOSARTAN POTASSIUM","","","Select","Select",""],["","","ALLOPURINOL","","","Select","Select",""],["","","ATORVASTATIN CALCIUM","","","Select","Select",""],["","","OXYCODONE HCL","","","Select","Select",""],["","","CYCLOBENZAPRINE HCL","","","Select","Select",""],["","","PREDNISONE","","","Select","Select",""],["","","BUMETANIDE","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","LAGEVRIO (EUA)","","","Select","Select",""],["","","ENTRESTO","","","Select","Select",""],["","","METOPROLOL TARTRATE","","","Select","Select",""],["","","MODERNA COVID BIVAL(6MO UP)EUA","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2022-23","","","Select","Select",""],["","","AMLODIPINE BESYLATE","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","",""],[],[""],[""],[""],[""],[""]],"comment":[["","","","",""],[],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"comment":[["","","","","",""],[],[""],[""],[""],[""],[""],[""],[""],[""],[""]],"sub":[]}}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}